Attachment 9
SUSENAS
VSEN93.LPK
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1993 NATIONAL SOCIO ECONOMIC SURVEY
CONSUMPTION OF PREPARED FOOD/BEVERAGES
(CONSUMPTION OF NON COOKING FOOD/BEVERAGES/
PREPARING BY HOUSEHOLD)
Confidential
01
02
03
04
05
06
07
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10
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02
I. LOCATION IDENTIFICATION
Province
District/Municipality *)
Sub-District
Village/Village Unit *)
Area
Urban
1 Rural
Enumeration area number
Segment group number
Packet number
Susenas Sample code number
Sample household serial number
Number of Household members
Name of Household head
II. ENUMERATION PARTICULARS
Name and NIP/NMS of
04
Name and NIP/
Enumerator:
NMS of supervisor
Date of Enumeration
05
Date of supervision:
03
Signature
*) Cross out inapplicable category
06
Signature
2
III. CONSUMPTION OF PREPARED FOOD/BEVERAGES BY THE HOUSEHOLD
DURING PREVIOUS WEEK DATED ……….1993 TO ……..1993
Day/Date
Type of prepared Quantity
Value (Rp)
Food origin
food/beverages
(1)
(2)
(3)
(4)
(5)
IV. PREPARED FOOD/BEVERAGES CONSUMED OUTSIDE THE HOUSEHOLD
DURING THE PREVIOUS WEEK DATES……….1993 TO ………….1993
Day/Date
Type of
Quantity
Value (Rp)
Food Origin
Name of
prepared
household
members
food/beverages
(1)
(2)
(3)
(4)
(5)
(6)